Cognitive reappraisal and attentional distraction constitute two core strategies for regulating emotions. Prior studies have largely focused on young adults regulating simple laboratory stimuli, with few direct comparisons of brain regions that differentiate or mutually implement these strategies. Here, we expanded the typical age range of participants, compared reappraisal and distraction within participants, and used ecologically valid autobiographical memories as regulatory targets. Sixty-two healthy adults aged 35-75 years generated cue words for negative and neutral autobiographical memories and were trained to either reappraise, distract, or let their emotions flow naturally in response to cued memories. Strategy-specific contrasts were derived from whole-brain fMRI data using univariate analyses. For reappraisal, relative to flow, we observed activity in bilateral occipital cortex, right cerebellum, and cingulate cortex and primarily left-sided frontal, temporal, and parietal cortices. Distraction, relative to flow, engaged bilateral lateral prefrontal, medial parietal, cingulate, occipital, and retrosplenial regions and left cerebellum. Common areas of activation included midline occipital and posterior cingulate cortices. Direct comparisons yielded strategy differences across multiple cortical areas: distraction engaged paralimbic areas (insula and left parahippocampal gyrus), dorsolateral and ventrolateral PFC, and right inferior frontoparietal cortex, whereas reappraisal engaged dorsomedial PFC, left ventrolateral PFC, anterior temporal cortex, and left posterolateral PFC. In-scanner valence ratings verified the efficacy of the experimental manipulation and revealed a negative impact of age on reappraisal success, which was correlated with greater visual cortical processing. These findings extend knowledge regarding the neural mechanisms of emotion regulation across the adult lifespan for autobiographical events.

Introduction Social connection and emotion regulation abilities shape mental health outcomes across the adult lifespan, influencing how individuals build psychological resilience and navigate stress. While emotion regulation abilities can be maintained with age, declines in white matter microstructure and social connection, defined here as the frequency and perceived quality of social interactions, are common, especially among adults with major depressive disorder (MDD). Prior research suggests that white matter microstructure supports cognitive reappraisal, an adaptive strategy for emotion regulation. Specifically, age-related declines in microstructural properties of white matter in the bilateral uncinate fasciculus and superior longitudinal fasciculus have been associated with cognitive reappraisal and cognitive control processes. The relationship between these neurocognitive changes and social connection warrants further investigation, as social connection is a predictor of well-being in late life, especially among older adults with MDD, who often experience social withdrawal and impairments in emotion regulation.Through newly available neuroimaging data from the Emotion Regulation Across the Lifespan and in Depression (EMERALD) study, we investigated whether cognitive reappraisal moderates the relationship between white matter integrity and social connection in middle-aged and older adults, both with and without MDD. This hypothesis is based on prior findings that reappraisal is associated with better social adjustment and resilience, as well as research indicating that white matter loss can negatively impact cognitive control mechanisms underlying emotion regulation and social engagement. We hypothesized that trait reappraisal ability would protect against the negative effects of white matter loss on social connection, with this protective effect being attenuated in MDD due to emotion regulation impairments common in depressed individuals. Methods Participants included 86 adults (29 with MDD, 57 healthy controls) ages 35 to 75, who were assessed for clinical diagnoses, emotion regulation ability, and social connection. Trait reappraisal ability and social connection were assessed using the Emotion Regulation Questionnaire (ERQ) and the Duke Social Support Index (DSSI), respectively. The DSSI provided two measures of social connection: the social interaction subscale (items 1-4), which quantifies the frequency of social contact and acts as a proxy for network size, and the subjective support subscale (items 5-10), which focuses on the perceived quality of interactions with family and friends. Diffusion tensor imaging (DTI) was used to assess the structural integrity (fractional anisotropy; FA) of the bilateral uncinate fasciculus (UF) and superior longitudinal fasciculus (SLF). Separate regression models were used to test how reappraisal moderated the relationship between white matter integrity and two social connection outcomes, both in the full sample and within the MDD and healthy control (HC) sub-samples. We predicted higher reappraisal ability would attenuate the negative association between white matter loss in bilateral UF and SLF pathways and social interaction. Similarly, we predicted higher reappraisal ability would buffer the impact of reduced white matter integrity on subjective support. Given the emotion regulation impairments common to depression, we predicted that the protective effect of reappraisal would be attenuated in the MDD group. Age was not significantly correlated with social connection outcomes or DTI metrics; therefore, analyses were conducted across the full sample. Results Within the whole sample, we found a significant interaction effect between reappraisal and left UF integrity for social interaction (β = -0.03, p = 0.025). Low reappraisers showed increased social interaction at higher left UF integrity values, while high reappraisers showed the opposite relationship. For the subjective support model, we found a significant interaction effect between reappraisal and right UF integrity (β = 3.80, p = 0.01). High reappraisers maintained relatively stable levels of subjective support across right UF integrity values, while low reappraisers showed decreased subjective support at higher integrity values.Within the MDD group, we found a significant interaction effect between reappraisal and integrity of left SLF for social interaction (β = -4.50, p = 0.042). Low reappraisers showed a positive relationship, where greater integrity of left SLF was associated with increased social interaction. In contrast, high reappraisers maintained a narrow range of left SLF integrity values and showed a slight negative relationship, with higher integrity values associated with decreased social interaction. For the subjective support model, we found a significant interaction effect between reappraisal and left UF integrity (β = -5.77, p = 0.010). The opposite effect was observed for low reappraisers, which aligns with the initial hypothesis. Analyses within the healthy control sample did not reveal significant interactions between reappraisal and white matter integrity on social connection outcomes. Conclusions The findings suggest that reappraisal moderates the relationship between left UF integrity and social interaction, with high reappraisers potentially relying more on cognitive control processes and low reappraisers on structural integrity. These results highlight that reappraisal may be a skill-based process that functions independently of white matter microstructure in high reappraisers. In the MDD group, left SLF integrity may be more influential for social interaction in low reappraisers due to greater cognitive load in individuals with depression. Notably, these effects were not observed in the healthy control group, suggesting that the relationship between cognitive reappraisal, white matter integrity, and social connection may be more pronounced in individuals with MDD.Contrary to our initial hypothesis, low reappraisers showed an inverse relationship between right UF integrity and subjective support, which warrants further investigation. High reappraisers showed stable levels of subjective support regardless of right UF integrity. Although age was not significantly correlated with social connection outcomes or white matter integrity in our sample, future research should explore whether subtle age-related structural differences influence emotion regulation and social behaviors in mid-to-late life populations. Overall, these findings emphasize the importance of further investigating the emotional and neurocognitive mechanisms underlying social connection to promote equitable and accessible mental health interventions for mid-late life.

Background Anhedonia remains a difficult-to-treat symptom and has been associated with poor clinical course transdiagnostically. Here, we applied machine learning models to individualized neural patches derived from fMRI data during the Monetary Incentive Delay Task in anhedonic participants (N = 67) recruited for a clinical trial examining K-opioid receptor (KOR) antagonism in the treatment of anhedonia. Methods Nine ensemble models were estimated using cortical, subcortical, and combined cortical subcortical features from individualized functional topographies to predict changes in symptoms of overall psychopathology (anhedonia, depression, anxiety). Analyses were performed on the KOR (N = 33) and placebo (N = 34) group. Results Initial models showed that only subcortical data predicting depression and anxiety symptom change had a significant Spearman correlation between veridical and predicted data (rho = 0.480 and rho = 0.415 respectively). Next, leave-one-out-cross-validation (LOOCV) showed that the best-performing models comprised only the subcortical individualized systems data, which correlated with clinical change for depression and anxiety scores for the KOR group with significantly higher accuracy (rho = 0.634 and rho = 0.562, respectively) compared to the placebo group (rho = 0.294 and rho = 0.034, respectively). Further, 25 subcortical neural features were identified based on correlation and ensemble determined importance in driving prediction. Final models for both depression and anxiety showed an overall higher representation of the dorsal attention network. Cortical and combined cortical-subcortical feature data showed no significant improvement in prediction of clinical change between the two groups. Conclusion Using an ensemble of machine learning approaches, we identified individual differences in subcortical individualized systems data that predicted clinical change that was specific to KOR antagonism.

BACKGROUND:Anhedonia, deficits in motivation and pleasure, is a transdiagnostic symptom of psychopathology and negative prognostic marker. METHODS:In this randomized, parallel-arm clinical trial, a novel intervention, Behavioral Activation Treatment for Anhedonia (BATA), was compared to an individually administered Mindfulness-Based Cognitive Therapy (MBCT) in a transdiagnostic cohort of adults with clinically significant anhedonia (ClinicalTrials.gov Identifiers NCT02874534 and NCT04036136). Participants received 8-15 individual psychotherapy sessions, once weekly, with either BATA (n = 61) or MBCT (n = 55) and completed repeated self-report assessment of anhedonia and other internalizing symptoms. RESULTS:Indicators of treatment feasibility were similar across conditions, though MBCT showed a trend towards greater attrition rates than BATA, with an adjusted odd's ratio of 2.04 [0.88, 4.73]. Treatment effects on the primary clinical endpoint of anhedonia symptoms did not significantly differ, with a 14-week estimated difference on the Snaith Hamilton Pleasure Scale (SHAPS) of -0.20 [-2.25, 1.84] points in BATA compared to MBCT (z = 0.19, p = 0.845, d = 0.05). The expected 14-week change in SHAPS scores across conditions was -7.18 [-8.22, -6.15] points (z = 13.6, p < 0.001, d = 1.69). There were no significant differences in the proportion of participants demonstrating reliable and clinically significant improvements in SHAPS scores, or in the magnitude of internalizing symptom reductions. LIMITATIONS:Limitations included a modest sample size, lack of longer-term follow up data, and non-preregistered analytic plan. DISCUSSION:There was no evidence to support superior clinical efficacy of BATA over MBCT in a transdiagnostic cohort of adults with elevated anhedonia. Both interventions reduced anhedonia symptoms to a comparable magnitude of other existing treatments.

Effective emotion regulation is critical for maintaining emotional health in the face of adverse events that accumulate over the lifespan. These abilities are thought to be generally maintained in older adults, accompanied by the emergence of attentional biases to positive information. Such age-related positivity biases, however, are not always reported and may be moderated by individual differences in affective vulnerabilities and competencies, such as those related to dispositional negative affect and emotion regulation styles. To examine these relationships, we analyzed eye-tracking data from 72 participants (35-74 years; 50 female), 44 without and 28 with a diagnosis of Major Depressive Disorder during a free-viewing task comprising neutral-neutral, negative-neutral, and positive-neutral image pairs. Emotional bias scores were calculated based on the ratio of time spent dwelling on the emotional image vs. the neutral image in each emotional-neutral pair. Results indicate that healthy participants exhibited a stronger positivity bias than a negativity bias, whereas individuals with higher depressive symptom scores showed no difference. Next, we examined how age and emotion regulation strategy use (reappraisal vs. suppression, measured with the Emotion Regulation Questionnaire) impacted these effects. Individuals with Major Depressive Disorder did not exhibit a significant relationship between age and positivity bias. However, for healthy participants who self-reported a preference for using reappraisal in daily life, increased age was associated with an increased positivity bias. These findings indicate that the emergence of the positivity effect in older adults is related to reappraisal regulatory preferences in the absence of depressive symptoms.

Anhedonia is a transdiagnostic clinical syndrome associated with significant clinical impairment. In spite of this, a clear network-level characterization of anhedonia does not yet exist. The present study addressed this gap in the literature by taking a graph theoretical approach to characterizing state-based (i.e., reward anticipation, rest) network dynamics in a transdiagnostic sample of adults with clinically significant anhedonia (n = 77). Analyses focused on three canonical brain networks: the Salience Network (SN), the Default Mode Network (DMN) and the Central Executive Network (CEN), with hypotheses focusing on the role of saliency-mapping in anhedonia. Contrary to hypotheses, no significant relation was found between the SN and anhedonia symptom severity. Exploratory results revealed a significant association between anhedonia severity and DMN reorganization from rest to reward anticipation. Specifically, greater anhedonia severity was associated with less reward-related reorganization. This finding suggests that anhedonia severity may be associated with DMN hyposensitivity, such that individuals with more severe anhedonia may have a difficult time disengaging from their internal world in the context of potentially rewarding experiences. Although preliminary, this finding challenges the centrality of the SN in anhedonia severity and suggests the importance of the DMN. Clinical implications and future directions are explored.

Background Emotional dysregulation is a serious and impairing mental health problem. We examined functional activity and connectivity of neural networks involved in emotional dysregulation at baseline and following a pilot neurostimulation-enhanced cognitive restructuring intervention in a transdiagnostic clinical adult sample. Methods Neuroimaging data were analyzed from adults who scored 89 or higher on the Difficulties with Emotion Regulation (DERS) scale and had at least one DSM-5 diagnosis. These participants were part of a pilot randomized, double-blind, placebo-controlled trial combining a single therapeutic session of cognitive restructuring with active or sham transcranial magnetic stimulation over the dorsolateral prefrontal cortex. During the study, participants engaged in an emotional regulation task using personalized autobiographical stressors while undergoing functional magnetic resonance imaging (fMRI) before and after the pilot intervention. The fMRI task required participants to either experience the emotions associated with the memories or apply cognitive restructuring strategies to reduce their distress. Results Whole-brain fMRI results during regulation at baseline revealed increased activation in the dorsal frontoparietal network but decreased activation in the supplementary motor area, cingulate cortex, insula, and ventrolateral prefrontal cortex (vlPFC). Emotion dysregulation was associated with greater vmPFC and amygdala activation and functional connectivity between these regions. The strength of functional connectivity between the dlPFC and other frontal regions was also a marker of emotional dysregulation. Preliminary findings from a subset of participants who completed the follow-up fMRI scan showed that active neurostimulation improved behavioral indices of emotion regulation more than sham stimulation. A whole-brain generalized psychophysiological interaction analysis indicated that active neurostimulation selectively increased occipital cortex connectivity with both the insula and the dlPFC. Region-of-interest functional connectivity analyses showed that active neurostimulation selectively increased dlPFC connectivity with the insula and orbitofrontal cortex (OFC). Conclusion Insufficient neural specificity during the emotion regulation process and over-involvement of frontal regions may be a marker of emotional dysregulation across disorders. OFC, vlPFC, insula activity, and connectivity are associated with improved emotion regulation in transdiagnostic adults. In this pilot study, active neurostimulation led to neural changes in the emotion regulation network after a single session; however, the intervention findings are preliminary, given the small sample size. These functional network properties can inform future neuroscience-driven interventions and larger-scale studies.

Introduction The regulation of emotion is crucial for sustaining mental health in the face of cumulative stressors over one's lifetime. Although it is well documented that some emotion regulation abilities are preserved or even improved in healthy aging, little is known about why regulatory deficits persist in older adults who suffer from depression. Treatments for major depressive disorder (MDD) focus on remediating affective dysregulation processes that confer risks for disability, poor quality of life, and morbidity into late life. Theoretical perspectives on emotional aging propose myriad lifespan changes that potentially impact regulatory capacities, including structural and functional integrity of dorsal attentional and ventral affective processing pathways, cognitive control in affective contexts, and use of specific regulatory strategies. Here, we investigated the relation of magnetic resonance imaging (MRI) measures of brain activation and connectivity to emotional dysregulation in older adults with and without depression. We also examined the differences among specific regulation strategies. We hypothesized that reappraisal would be a cognitive emotion regulation strategy that is highly effective in younger adults, but less effective for older adults and individuals with affective disorders. In contrast, we hypothesized that distraction, defined as intentional shifting of attention from a distressing stimulus to a different attentional target, would be effective independently of age and presence of depression. Methods A total of 94 adults (28 with MDD, 66 nondepressed) ages 35 to 75 were assessed for clinical diagnosis, depression severity, and cognitive status. Participants were assessed for cognitive control (task switching efficiency) and affective bias (eye tracking dwell time on negative versus positive images). After being trained in reappraisal and distraction regulation strategies, participants were scanned using event-related functional MRI while being cued to reappraise, distract from, or allow emotions ("flow") induced from cued personal negative memories. Diffusion tensor imaging (DTI) data were also acquired to provide structural information (fractional anisotropy; FA) about relevant white matter tracts: bilateral uncinate fasciculus (UF) and superior longitudinal fasciculus (SLF II). Factor analysis was used to compute composite variables reflecting affective network (AN) and dorsal attention network (DAN) integrity composed of regional brain activation during reappraisal or distraction relative to during "flow," functional connectivity during reappraisal or distraction relative to during "flow," and average FA within UF and SLF II. Several linked regression models were used to test two sets of hypotheses. For reappraisal, we predicted that age, depression severity, and gender would predict cognitive control ability, negative affective bias, and AN integrity, with the latter three variables predicting reappraisal success in the scanner. For distraction, we predicted that age, depression severity, and gender would predict cognitive control ability, positive affective bias, and DAN integrity, with the latter three variables predicting distraction success in the scanner. We tested these models both in the whole sample and in the MDD subsample separately. Results In the whole sample, older age predicted lower AN integrity, B = -0.03, p < 0.05, but AN integrity did not predict overall reappraisal success. For the distraction model, older age predicted lower DAN integrity, B = -0.02, p < 0.05. Both older age and depression severity (Beck Depression Inventory 2 scores) predicted increased positive affective bias, B = 0.28, p < 0.001 and B = 0.35, p < 0.05, respectively. However, neither DAN integrity nor positive bias predicted distraction success. For the MDD group, increased age again predicted lower AN integrity, B = -0.08, p < 0.05, but none of the included variables predicted reappraisal success. For the distraction model in the MDD group, both age (B = -0.05, p < 0.05) and depression severity (B = 0.04, p < 0.05) predicted DAN integrity. DAN integrity did predict distraction success in the MDD group, B = 0.47, p < 0.05. Conclusions The analyses suggested that age, and to a limited extent depression severity, predicted activation and connectivity in AN and DAN. However, we found only limited evidence that network integrity predicted emotion regulation success. Overall, the findings did not support hypotheses that cognitive control ability and affective bias impact the success of individual episodes of reappraisal or distraction in adults in mid- to late-life. The distraction strategy, in particular, may be an informative target for future studies on the neurocognitive predictors of emotion regulation in aging and depression.

BACKGROUND:Anhedonia is a transdiagnostic symptom often resistant to treatment. The identification of biomarkers sensitive to anhedonia treatment will aid in the evaluation of novel anhedonia interventions. METHODS:This is an exploratory analysis of changes in subcortical brain volumes accompanying psychotherapy in a transdiagnostic anhedonic sample using ultra-high field (7-Tesla) MRI. Outpatients with clinically impairing anhedonia (n = 116) received Behavioral Activation Treatment for Anhedonia, a novel psychotherapy, or Mindfulness-Based Cognitive Therapy (ClinicalTrials.gov Identifiers NCT02874534 and NCT04036136). Subcortical brain volumes were estimated via the MultisegPipeline, and regions of interest were the amygdala, caudate nucleus, hippocampus, pallidum, putamen, and thalamus. Bivariate mixed effects models estimated pre-treatment relations between anhedonia severity and subcortical brain volumes, change over time in subcortical brain volumes, and associations between changes in subcortical brain volumes and changes in anhedonia symptoms. RESULTS:As reported previously (Cernasov et al., 2023), both forms of psychotherapy resulted in equivalent and significant reductions in anhedonia symptoms. Pre-treatment anhedonia severity and subcortical brain volumes were not related. No changes in subcortical brain volumes were observed over the course of treatment. Additionally, no relations were observed between changes in subcortical brain volumes and changes in anhedonia severity over the course of treatment. LIMITATIONS:This trial included a modest sample size and did not have a waitlist-control condition or a non-anhedonic comparison group. CONCLUSIONS:In this exploratory analysis, psychotherapy for anhedonia was not accompanied by changes in subcortical brain volumes, suggesting that subcortical brain volumes may not be a candidate biomarker sensitive to response to psychotherapy.

Objective: Homework is a key theoretical component of cognitive-behavioral therapies, however, the effects of homework on clinical outcomes have largely been evaluated between-persons rather than within-persons.Methods: The effects of homework completion on treatment response were examined in a randomized trial comparing Behavioral Activation Treatment for Anhedonia (BATA, n = 38), a novel psychotherapy, to Mindfulness-Based Cognitive Therapy (MBCT, n=35). The primary endpoint was consummatory reward sensitivity, measured weekly by the Snaith Hamilton Pleasure Scale (SHAPS), up to 15 weeks. Multilevel models evaluated change in SHAPS scores over time and the effects of clinician-reported and participant-reported homework.Results: BATA and MBCT resulted in significant, equivalent reductions in SHAPS scores. Unexpectedly, participants who completed greater mean total amounts of homework did not improve at a faster rate (i.e., no betweenperson effect). However, sessions with greater than average participant-reported homework completion were associated with greater than average reductions in SHAPS scores (i.e., a within-person effect). For clinicianreported homework, this effect was only evident within the BATA condition.Conclusion: This study shows psychotherapy homework completion relates to symptomatic improvement in cognitive-behavioral treatments for anhedonia when session-to-session changes are examined within-person. On the contrary, we found no evidence that total homework completion predicted greater improvements betweenperson. When possible, psychotherapy researchers should evaluate their constructs of interest across multiple sessions (not just pre/post) to allow more direct tests of hypotheses predicted by theoretical models of individual change processes.

Background Chronic stress alters reward sensitivity and contributes to the emergence of anhedonia. In clinical samples, the perception of stress is a strong predictor of anhedonia. While there is substantial evidence demonstrating psychotherapy reduces perceived stress, little is known regarding the effects of treatment-related decreases in perceived stress on anhedonia. Methods The current study investigated reciprocal relations between perceived stress and anhedonia using a cross-lagged panel model approach in a 15-week clinical trial examining the effects of Behavioral Activation Treatment for Anhedonia (BATA), a novel psychotherapy to treat anhedonia, compared to a Mindfulness-Based Cognitive Therapy (MBCT) comparison intervention (ClinicalTrials.gov Identifiers NCT02874534 and NCT04036136). Results Treatment completers (n=72) experienced significant reductions in anhedonia (M=-8.94, SD=5.66) on the Snaith-Hamilton Pleasure Scale (t(71)=13.39, p<.0001), and significant reductions in perceived stress (M=-3.71, SD=3.88) on the Perceived Stress Scale (t(71)=8.11, p<.0001) following treatment. Across all treatment-seeking participants (n=87), a longitudinal autoregressive cross-lagged model revealed significant paths showing that higher levels of perceived stress at treatment Week 1 predicted reductions in anhedonia at treatment Week 4. Conclusions Longitudinal models illustrated that individuals with relatively high perceived stress at the start of treatment were likely to report relatively lower anhedonia a few weeks into treatment. At mid-treatment, individuals with low perceived stress were more likely to report lower anhedonia towards the end of treatment. Early treatment components are thought to reduce perceived stress, allowing for mid-to-late treatment components to exert their direct effects on anhedonia. The findings presented here demonstrate the importance of including stress-reducing components in cognitive-behavioral-based anhedonia treatments.

Background: Growing evidence indicates that anhedonia is a multifaceted construct. This study examined the possibility of identifying subgroups of people with anhedonia using multiple reward-related measures to provide greater understanding the Research Domain Criteria's Positive Valence Systems Domain and pathways for developing treatments. Methods: Latent profile analysis of baseline data from a study that examined the effects of a novel kappa opioid receptor (KOR) antagonist drug on measures and biomarkers associated with anhedonia was used to identify subgroups. Measures included ventral striatal activation during the Monetary Incentive Delay task, response bias in the Probabilistic Reward Task, reward valuation scores from the Effort-Expenditure for Rewards Task, and scores from reward-related self-report measures. Results: Two subgroups were identified, which differed on self-report measures of reward. Participants in the subgroup reporting more anhedonia also reported more depression and had greater illness severity and functional impairments. Graphs of change with treatment showed a trend for the less severe subgroup to demonstrate higher response to KOR antagonist treatment on the neuroimaging measure, probabilistic reward task, and ratings of functioning; the subgroup with greater severity showed a trend for higher treatment response on reward-related self-report measures. Limitations: The main limitations include the small sample size and exploratory nature of analyses. Conclusions: Evidence of possible dissociation between self-reported measures of anhedonia and other measures with respect to treatment response emerged. These results highlight the importance for future research to consider severity of self-reported reward-related deficits and how the relationship across measurement methods may vary with severity.

This study assessed the relationship between modifiable psychological variables and depression, anxiety, and posttraumatic growth in women experiencing infertility. U.S. women (N = 457) who identified as experiencing infertility completed standardized self-report measures of mindfulness, self-compassion, positive affect, intolerance of uncertainty, relationship satisfaction, experiential avoidance, depression, anxiety, and posttraumatic growth. Clinical and demographic characteristics (age, duration trying to conceive, miscarriage, and childlessness) did not predict depression or anxiety. Lower positive affect and higher experiential avoidance were associated with depression and anxiety. Lower self-compassion was associated with depression; higher intolerance of uncertainty was associated with anxiety. There were indirect effects of mindfulness on anxiety and depression via these variables. Future research should explore whether intervening on these factors reduces depressive and anxiety symptoms. Promoting mindfulness may have beneficial effects on symptoms via its downstream effects on multiple coping variables. Counterintuitively, posttraumatic growth was associated with higher intolerance of uncertainty and experiential avoidance.

Introduction: Psychological distress among women experiencing infertility is high. The purpose of this study was to assess women's preferences toward various psychological intervention formats to manage stress during infertility treatment, and to gauge interest in an online mindfulness-based intervention in particular. Materials and Methods: Participant (N?=?272) recruitment included in-person and online methods: (1) patients completed surveys in a fertility clinic waiting room and (2) an electronic link to the survey was shared on social media platforms relevant to individuals experiencing infertility. Results: Participants were highly interested in receiving psychological support in multiple formats. Participants showed a clear preference for behavioral interventions over pharmacotherapy. Ninety percent of participants reported they were willing to practice a designated coping skill two to three times per week or daily. On average, participants rated their interest in using a mindfulness app to help manage uncertainty and stress during fertility treatment as 7.78 on a scale of 0?10. Conclusion: Women experiencing infertility are highly interested in receiving psychological support, and are open to a variety of intervention formats.

BACKGROUND:Despite negative associations of trait resilience with depression and anxiety symptoms, the mechanisms by which resilience may buffer against these symptoms remain underexplored. This study investigated emotion regulation difficulties as a potential link in the relationship between trait resilience and depression and anxiety severity in psychiatric outpatients (N = 353).METHODS:Participants diagnosed with primary depression or anxiety disorders were evaluated prior to treatment initiation with the Connor-Davidson Resilience Scale, Difficulties in Emotion Regulation Scale (DERS), Clinically Useful Depression Outcome Scale (CUDOS), and Clinically Useful Anxiety Outcome Scale (CUXOS).RESULTS:In the depression sample, the effect of resilience on CUDOS scores was fully mediated by total DERS scores. In the anxiety sample, the effect of resilience on CUXOS scores was partially mediated by total DERS scores. Exploratory parallel mediation analyses showed only the DERS subscale strategies had a significant effect on CUDOS scores, while only goals had a significant effect on CUXOS scores.CONCLUSIONS:Emotion regulation difficulties are a mediator of trait resilience in psychiatric outpatients. For patients seeking treatment for depression, difficulties with accessing emotion regulation strategies may be particularly relevant, while difficulties meeting one's goals may be most relevant for patients seeking treatment for anxiety.

Background Transdiagnostic clinical emotional dysregulation is a key component of psychopathology and offers an avenue to address multiple disorders with one transdiagnostic treatment. In the current study, we pilot a one-time intervention that combines cognitive restructuring (CR) with repetitive transcranial magnetic stimulation (rTMS), targeted using functional magnetic resonance imaging (fMRI). Methods Thirty-seven clinical adults with high emotional dysregulation were enrolled in this randomized, double-blind, placebo-controlled trial. fMRI was collected as participants were reminded of lifetime stressors and asked to downregulate their distress using CR tactics. fMRI BOLD data were analyzed to identify the cluster of voxels within the left dorsolateral prefrontal cortex (dlPFC) with the highest activation when participants attempted to downregulate, versus passively remember, distressing memories. Participants underwent active or sham rTMS (10 Hz) over the target while practicing CR following autobiographical emotional induction. Results Receiving active versus sham rTMS led to significantly higher high frequency heart rate variability during regulation, lower regulation duration, and higher likelihood to use CR during the week following the intervention. There were no differences between conditions when administering neurostimulation without CR compared to sham. Participants in the sham versus active condition experienced less distress the week after the intervention. There were no differences between conditions at the one-month follow up. Conclusion This study demonstrated that combining active rTMS with emotion regulation training significantly enhances emotion regulation and augments the impact of training for as long as a week. These findings are a promising step towards a combined intervention for transdiagnostic emotion dysregulation.

Anhedonia is a transdiagnostic symptom characterized by the inability to feel motivation for, or pleasure from rewarding experiences. Subcortical networks are broadly implicated in the pathophysiology of anhedonia though no research to date has examined relations between volumes of subcortical structures, anhedonia severity, and reward-oriented behaviors.